The influence of age and sex on the relationship between heart rate variability, haemodynamic variables and subjective measures of acute post-operative pain

Ledowski, Thomas; Stein, J.; Albus, Sebastian; MacDonald, B.

doi:10.1097/eja.0b013e328343d524

Cited by 37 publications

(50 citation statements)

References 21 publications

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“…Although, it is not clear whether pain in the postoperative period affects HRV; some studies suggested that pain may influence HRV and the sympathovagal balance [27,28], and others have not been able to show this correlation [16,29].…”

Section: Discussionmentioning

confidence: 99%

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Hansen

Rosenberg

Gögenur

2013

Breast Cancer Res Treat

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Changes in the autonomic nervous system with increased sympathetic tone may be a cause of postoperative short-, and long-term cardiovascular complications. Heart rate variability (HRV) is assessed by Holter monitoring as a measure of autonomic tone and has not been investigated in patients with breast cancer undergoing surgery. We aimed to investigate evening- and night-time HRV after lumpectomy. Twelve patients were included in this descriptive study. HRV was measured the night before surgery (PREOP), the night after surgery (PO1) and 14 days after surgery (PO14) from 1900 to 0700 h. For calculation of HRV, time domain parameters (SDNN-standard deviation of all normal-to-normal (NN) intervals around the mean NN for the period of measurement, pNN50-percentage of beats where the change from one beat to the next is more than 50 ms, rMSSD-root mean square of successive differences) were used. We analyzed the variation of the overall time period and the circadian variation between evening and night (sympathetic vs. parasympathetic tonus). Mean heart rate increased from PREOP to PO1 (p < 0.001) and also increased between PREOP and PO14 (p < 0.05). SDNN (p < 0.001) and PNN50 (p < 0.001) decreased from PREOP to PO1. There was also a significant decrease between PREOP and PO14 for both parameters (p < 0.005 and p = 0.05 respectively). SDNN increased from PO1 to PO14 (p < 0.005). rMSSD decreased from PREOP to PO1 (p < 0.001). A circadian variation was found in the mean heart rate for all three monitoring periods (p < 0.005). Circadian variation was also present on PREOP for pNN50 (p ≤ 0.05) and rMSSD (p < 0.05). This variation was missing for both PO1 and PO14. Patients had a shift of autonomic tone with reduced parasympathetic activity and lack of circadian variation 14 days after lumpectomy.

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Section: Discussionmentioning

confidence: 99%

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Hansen

Rosenberg

Gögenur

2013

Breast Cancer Res Treat

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“…This discordance between subjective and objective measures is not only observed in stress research, but has also been highlighted in various other disciplines (for example, subjective pain and sleep experiences [15], [16]). Understanding the mismatch between subjective and objective ratings may help better understanding these various states, and eventually lead to improved interventions.…”

Section: Introductionmentioning

confidence: 96%

The Combined Propranolol/TSST Paradigm – A New Method for Psychoneuroendocrinology

Andrews

Pruessner

2013

PLoS ONE

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Upon perception of a stimulus as stressful, the human brain reacts with the activation of the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), to mobilize energy resources to better cope with the stressor. Since the perception of the stressor is the initial stimulus, a synchronicity between the subjective perception of stress and the physiological stress reactivity should be expected. However, according to a recent meta-analysis, these associations are weak and inconsistent. The goal of the current study was to investigate the interaction between the SNS, HPA and subjective stress perceptions, by introducing an experimental manipulation of this interaction. For this purpose, we combined the SNS inhibitor propranolol with the Trier Social Stress Test, and measured endocrinological and psychological responses to the stressor. Thirty healthy male participants were recruited and randomly assigned to either a propranolol (PROP; n = 15) or placebo (PLC; n = 15) group. All subjects were administered 80 mg of propranolol 60 minutes prior to exposure to psychosocial stress. Salivary cortisol and alpha amylase (sAA), heart rate, blood pressure and subjective stress responses were assessed throughout the study. We observed significantly reduced sAA levels and heart rate increases in the PROP group in response to stress, with no effects of the drug on systolic or diastolic blood pressure changes. In line with previous studies, a significant increase in cortisol was seen in response to the stress exposure. Importantly, the cortisol increase was significantly higher in the PROP group. A typical increase in subjective stress could be seen in both groups, with no significant group differences emerging. Complementing previous work, this study further demonstrates a significant interaction between the HPA and the SNS during acute stress. The HPA activity was found to be elevated in the presence of a suppressed SNS in reactivity to the TSST.

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“…22,24,26,28,31,33,37,39 Transcutaneous oxygen, skin conductance, and the analgesia/nociception index (calculated from HR variability) have been assessed in patients experiencing pain with inconsistent conclusions. 23,27,31,32,34,38,[40][41][42] Patients with severe pain who show no hypertension or tachycardia to substantiate their pain intensity might not receive the aggressive pain treatment they warrant. Our study aimed to determine whether vital signs are associated with pain intensity levels in both the ED population and a subgroup of patients with diagnosed conditions recognized to produce significant pain.…”

Section: Introductionmentioning

confidence: 99%

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

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Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain. Methods: We performed a retrospective analysis of real-time, archived data from an electronic medical record system at an urban teaching hospital and regional community hospital. We included consecutive ED patients ≥16 years old who had a self-reported pain intensity ≥1 as measured during triage, from March 2005 to December 2012. The primary outcome was vital signs for self-reported pain intensity levels (mild, moderate, severe) on an 11-point verbal numerical scale. Changes in pain intensity levels were also compared to variations in vital signs. Both analyses were repeated on a subgroup of patients with diagnosed conditions recognized to produce significant pain: fracture, dislocation, or renal colic. Results: We included 153,567 patients (mean age of 48.4 ± 19.3 years; 55.5% women) triaged with pain (median intensity of 7/10 ± 3). Of these, 8.9% of patients had diagnosed conditions recognized to produce significant pain. From the total sample, the difference between mild and severe pain categories was 2.7 beats/minutes (95% CI: 2.4 − 3.0) for heart rate and 0.13 mm Hg (95% CI: -0.26 − 0.52) for systolic blood pressure. These differences generated small effect sizes and were not clinically significant. Results were similar for patients who experienced changes in pain categories and for those conditions recognized to produce significant pain. Conclusion: Health care professionals cannot use vital signs to estimate or substantiate self-reported pain intensity levels or changes over time. RÉSUMÉObjectif: L'étude visait à confirmer l'existence d'une association entre l'intensité de la douleur autodéclarée et les signes vitaux enregistrés chez des patients au service des urgences (SU) ainsi que dans un sous-groupe de malades souffrant d'affections connues pour causer de fortes douleurs. Méthode: Les auteurs ont procédé à une analyse rétro-spective de données enregistrées en temps réel et archivées dans un système de dossiers médicaux électroniques, dans un centre hospitalier universitaire urbain et dans un hôpital communautaire régional. Ont participé à l'étude des patients consécutifs, âgés de ≥16 ans, qui ont fait état, au SU, de douleurs d'une intensité ≥1, mesurée durant le triage, de mars 2005 à décembre 2012. Le principal critère d'évaluation était les signes vitaux associés à différents degrés d'intensité (légère, modérée, forte) de la douleur autodéclarée sur une échelle numérique, verbale, de 11 points. Les variations de l'intensité de la douleur ont également été comparées aux variations des signes vitaux. Les deux analyses ont été reprises dans un sous-groupe de patients souffrant d'affections connues pour causer de fortes douleurs: fracture, luxation ou colique néphrétique. Résultats: Ont participé à l'étude 153 567 patients (âge moyen: 48,4 ± 19,3 ans; femm...

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The influence of age and sex on the relationship between heart rate variability, haemodynamic variables and subjective measures of acute post-operative pain

Abstract: Acute pain influences the sympathovagal balance. This response is significantly influenced by age and sex.

Cited by 37 publications

References 21 publications

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

The Combined Propranolol/TSST Paradigm – A New Method for Psychoneuroendocrinology

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

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